The Children's Health Insurance Program (CHIP): A History on the Program and Bills Passed Affecting Eligibility
Texas has the highest rate of uninsured children in the country.... approximately 1.5 million or simply said, one in five children in Texas are uninsured. The Children's Health Insurance Plan was first introduced ten years ago in 1999 during the 76th Legislature. This bill has undergone several revisions in the Texas legislature since its inception. The goal of CHIP is to provide primary and preventative health care to children from working class families whose annual income disqualifies them from receiving Medicaid. CHIP was also created to ensure that children from working class families that could not afford private health insurance had access to health care.
In the 78th Legislature, Regular session 2003, the CHIP program restricted access to thousands of low-income working class families based on asset restrictions. Asset restrictions were placed on deductions for calculating family income making it more difficult for low income families to qualify for the plan as well as to renew their coverage. The current law caps participation to families who earn up to $44,000 in annual earnings for a family of four.
In the 80th Legislature, HB-109 made significant steps in restoring the CHIP program, it deducted child careexpenses when calculating income, doubled the assets test limit from $5,000 to $10,000 and increased eligibility in the program for a total of 12 months with an income review scheduled at six months.
The goal of state Rep. Garnet Coleman, D-Houston, who is the author of HB 2962, in this 81st Legislature is to increase enrollment and public awareness of CHIP. HB 2962 will restore the CHIP program to pre-2003 levels by changing asset qualifications, simplifying the application for renewal, expanding eligibility, providing a buy-in option for children with a net family income of 300-400 percent of the federal poverty level, and ensuring that private insurance is not being substituted by CHIP coverage.
An interesting fact: For every dollar invested in CHIP, the State of Texas receives approximately $2.65 in matching federal funds. To date, Texas has turned away over $1 billion in these federal matching funds.
Author of HB 2962: Rep. Garnet Coleman, D-Houston, has served the people of District 147 in the Texas House of Representatives continuously since 1991.He is the son of John B. Coleman, M.D., a prominent Houston Third ward physician, public servant and humanitarianwhose life was dedicated to serving the Houston community. With a strong family history in healthcare, Rep. Garnet Coleman is a member of the House Committee on Public Health and the House Committee on County Affairs. He is an advocate of for voting rights of people of color, obtaining healthcare coverage for at-risk children and has worked diligentlyto increase services and decrease the stigma associated with mental illness.
Joint Authors of HB 2962:
Rep. Dawnna Dukes, D- Austin, has served eight terms in the House of Representatives and serves District 46, which represents inner city East Austin and Travis County. She is a member of the Appropriations Committee, the Stimulus Subcommitee on Appropriations, member of the Health and Human Services subcommitee on Appropriations, as well as a member of the Culture, Recreation and Tourism Committee. During the 80th Legislative sesion, Dawnna Dukes served as Chair on the Special Issues on Appropriation and was instrumental in securing 89 million dollars for the Health and Human Services budget in order to expand the CHIP program in the past legislative session. She also lead the charge against the Laubenberg amendment to eliminate Perinatal CHIP program which ultimately would have removed 70,000 children per month from the CHIP rolls.
Rep. John Zerwas, R- Fulshear, represents District 28, which represents portions of Fort Bend, Waller and Wharton. Currently, he is the only physician in the House of Representatives and has been a physician, namely in Anesthesiology, for over 20 years. He was President of the Texas Society of Anesthesiologists from 1996-1997. He became Chief Medical Officer of Memorial Hermann Healthcare in 2003. During the 80th Legislature, Rep. John Zerwas authored House Bill 1594 to amend the Texas Insurnace Code. The bill expedites credentialing for physicians trying join an established medical group if that physician has a current contract with a managed care plan and ensures that their patients do not pay higher, out-of-network costs. His medical background and experience allows him to understand the complexities of the ever changing field of healthcare.
Rep. John E. Davis, R- Houston, represents District 129 in Harris County and has been in the House since 1999. He is a business owner and serves on Commitees of County Affairs and Public Health.
Rep.Elliot Naishtat, D-Austin, represents District 49 in Austin. He was elected to the Texas House of Representatives in 1990. Currently he is the Vice Chair of Public Health and the Vice Chair of Human Services. Rep. Naishtat has an interesting background, he originally came to Texas from Queens, New York as a VISTA volunteer and trainer under Lyndon Johnson's War on Poverty. Naishtat's background and career have definitely shaped his interests on the war on poverty, to better understand his position on the CHIP bill look here.
Analysis of the CHIP Bill:
General CHIP provisions: HB 2962 would increase family allowable asset limit from $10,000 to $20,000. Under the currnet plan, a family's vehicle is considered as an asset and caps that value at $18,000. Under the proposed bill that cap will be eliminated from the calculation of such allowable assets. Child support payments will also be excluded from assets when determining eligibility. Review of CHIP enrollees at the six month mark in order to determine ongoing eligibility will also be eliminated.
Increased CHIP eligibility: Enrollees whose net family incomes were greater than 200 percent but less than 300 percent of the federal poverty level are required to pay a share of the CHIP plan costs, not to exceed 5% of the enrollees net family income. Payment for the plan will be obtained through co-payments, fees and assessing a plan premium. The House bill proposes that plan coverage will be terminated for non-payment of premiums and that if a family's net income increases, that family's share costs will also increase.
CHIP buy-in program: This is a program that would be adopted by the executive of the Health and Human Services Commission (HHSC) that would allow certain children whose net family incomes that were greater than 300% of the federal poverty level but not exceeding 400% to buy CHIP coverage at the same cost that HHSC would pay for coverage. Children would only be eligible for thihs program if they had previously been enrolled in CHIP or Medicaid but were no longer eligible for the plans based on an increase in family income. This is a full cost buy-in option, that would be at no cost to the state.
Community Outreach: Under HB 2962, the HHSC would be required to improve existing public education regarding CHIP, assist with applications, and issue resolutions in eligibility determination processes.
Exclusion of college savings plans: Under HB 2962, the HHSC could no longer consider assets for college savings plans for the purpose of establishing income and resource eligibility.
The Timeline for HB 2962:
First Stage: Bill filed by Coleman on 3/10/2009.
Second Stage: Bill reported out of House committee on Human Services on 04/28/2009 with vote of 8 Ayes, 0 Nays, 0 Present Not Voting, 1 Absent.
Third Stage: Bill passed the House on 5/17/2009
The current status of the Bill as of June 1st, 2009: The Bill dies on the floor of the Senate
LInk to the statesman.com: What passed and what didn't in the 81st Legislative Sessionhere
Arguments For and Against the CHIP Bill:
In a Texas House of Representatives News Release on May 18, 2009, Rep. Ellen Cohen stated that,"Children living in middle-income families are increasingly joining the ranks of the uninsured because employer-based health insurance premiums have more than doubled since 2000. Reducing the number of uninsured children, now one in five, would benefit not only the children's physical health but the fiscal strength of Texas taxpayers."
In a quote in the Texas Insider, Rep. Roberto Alonzo D-Dallas, a co-author of HB-2962 says,"I am proud indeed to go bat for the innocent, voiceless children of Texas because they deserve our love and support. There is no doubt in my mind that any investment we make in our children today-- including adequate health care coverage--will translate into savings in the future many times over. And unless we take care of them now, we may be faced with much more serious problems and costly expenses later if we fail to act as policymakers."
Rep. Veronica Gonzales, D-McAllen, a supporter and co-author of the CHIP bill stated in the Rio Grande Guardian,"This is not an entitlement program. The average cost in Texas for private family health care coverage is $900 a month. Many families are now earning a few dollars more than the current eligibility level. The extended CHIP coverage will not only improve the health care of Texas children, it will also save the state money due to less costly emergency room visits and bring our state $3 federal match for each dollar we spend on CHIP."
Rep. Garnet Coleman, D-Houston offers his opinion on the bill," CHIP is not an entitlement program. These families pay to participate. The way Texas has laid it out, the families who partiucipate understand its not a free ride. We are ensuring that private health insurance is not substituted by CHIP coverage by including new, strict anti-crowd out provisions in this bill. Parents of children covered under the new provisions will contribute more to the cost of their children's health care than the state."
The Texas Chip Coalition is a public education and advocacy group that formed in 1988 and whose sole purpose is to support adequate state funding and program improvements for CHIP. The Texas Chip Coalition Principles designed for the 81st Legislative Session is included here.
Talmadge Heflin, the director of the Texas Public Policy Foundationfor Fiscal Policy shares his views regarding the passage of the CHIP House Bill,"Today's House vote is a harmful step toward a big government healthcare system. If Texas extends CHIP to families making more than $66,000 per year, what was originally a health insurance program for the working poor will morph into an expensive entitlement for the middle class.The buy-in option for families making more than $66,000 will crowd out the private insurance market, making health insurance less accesible and more expensive for families that do not qualify for CHIP. "
Governor Rick Perry expresses his opinion regarding the CHIP bill and its inclusion of the broader income eligibility criteria,"I would probably not be in favor of that expansion, even if it came to my desk. The members know that.That’s not what I consider to be a piece of legislation that has the vast support of the people of Texas.” In the 81st Legislative Session Governor Rick Perry has threatened to veto anybill related to expanded CHIP coverage.
Rep. Jodie Laubenberg, R-Parker, is also opposed the CHIP expansion and has assured her district that her opposition to the CHIP plan has, “nothing to do with children. It’s just more expansion of government health care. CHIP is the door to universal health care."
In response to Laubenberg's statement, Anne Dunkelberg, associate director of the Center for Public Policy Priorities, which advocates for low- and middle income Texans,“Today, the House ignored the will of the majority of Texans who wanted their state officials to do something about the growing number of uninsured children.”
This final statement by Dunkleberg really punctuates the knowledge that we gained in class about the power of government and whether or not government serves to reflect and represent its people.
The Children's Health Insurance Program (CHIP): A History on the Program and Bills Passed Affecting Eligibility
Texas has the highest rate of uninsured children in the country.... approximately 1.5 million or simply said, one in five children in Texas are uninsured.
The Children's Health Insurance Plan was first introduced ten years ago in 1999 during the 76th Legislature. This bill has undergone several revisions in the Texas legislature since its inception. The goal of CHIP is to provide primary and preventative health care to children from working class families whose annual income disqualifies them from receiving Medicaid. CHIP was also created to ensure that children from working class families that could not afford private health insurance had access to health care.
In the 78th Legislature, Regular session 2003, the CHIP program restricted access to thousands of low-income working class families based on asset restrictions. Asset restrictions were placed on deductions for calculating family income making it more difficult for low income families to qualify for the plan as well as to renew their coverage. The current law caps participation to families who earn up to $44,000 in annual earnings for a family of four.
In the 80th Legislature, HB-109 made significant steps in restoring the CHIP program, it deducted child careexpenses when calculating income, doubled the assets test limit from $5,000 to $10,000 and increased eligibility in the program for a total of 12 months with an income review scheduled at six months.
The goal of state Rep. Garnet Coleman, D-Houston, who is the author of HB 2962, in this 81st Legislature is to increase enrollment and public awareness of CHIP. HB 2962 will restore the CHIP program to pre-2003 levels by changing asset qualifications, simplifying the application for renewal, expanding eligibility, providing a buy-in option for children with a net family income of 300-400 percent of the federal poverty level, and ensuring that private insurance is not being substituted by CHIP coverage.
An interesting fact: For every dollar invested in CHIP, the State of Texas receives approximately $2.65 in matching federal funds. To date, Texas has turned away over $1 billion in these federal matching funds.
Author of HB 2962:
Rep. Garnet Coleman, D-Houston, has served the people of District 147 in the Texas House of Representatives continuously since 1991. He is the son of John B. Coleman, M.D., a prominent Houston Third ward physician, public servant and humanitarian whose life was dedicated to serving the Houston community. With a strong family history in healthcare, Rep. Garnet Coleman is a member of the House Committee on Public Health and the House Committee on County Affairs. He is an advocate of for voting rights of people of color, obtaining healthcare coverage for at-risk children and has worked diligently to increase services and decrease the stigma associated with mental illness.
Joint Authors of HB 2962:
Rep. Dawnna Dukes, D- Austin, has served eight terms in the House of Representatives and serves District 46, which represents inner city East Austin and Travis County. She is a member of the Appropriations Committee, the Stimulus Subcommitee on Appropriations, member of the Health and Human Services subcommitee on Appropriations, as well as a member of the Culture, Recreation and Tourism Committee. During the 80th Legislative sesion, Dawnna Dukes served as Chair on the Special Issues on Appropriation and was instrumental in securing 89 million dollars for the Health and Human Services budget in order to expand the CHIP program in the past legislative session. She also lead the charge against the Laubenberg amendment to eliminate Perinatal CHIP program which ultimately would have removed 70,000 children per month from the CHIP rolls.
Rep. John Zerwas, R- Fulshear, represents District 28, which represents portions of Fort Bend, Waller and Wharton. Currently, he is the only physician in the House of Representatives and has been a physician, namely in Anesthesiology, for over 20 years. He was President of the Texas Society of Anesthesiologists from 1996-1997. He became Chief Medical Officer of Memorial Hermann Healthcare in 2003. During the 80th Legislature, Rep. John Zerwas authored House Bill 1594 to amend the Texas Insurnace Code. The bill expedites credentialing for physicians trying join an established medical group if that physician has a current contract with a managed care plan and ensures that their patients do not pay higher, out-of-network costs. His medical background and experience allows him to understand the complexities of the ever changing field of healthcare.
Rep. John E. Davis, R- Houston, represents District 129 in Harris County and has been in the House since 1999. He is a business owner and serves on Commitees of County Affairs and Public Health.
Rep.Elliot Naishtat, D-Austin, represents District 49 in Austin. He was elected to the Texas House of Representatives in 1990. Currently he is the Vice Chair of Public Health and the Vice Chair of Human Services. Rep. Naishtat has an interesting background, he originally came to Texas from Queens, New York as a VISTA volunteer and trainer under Lyndon Johnson's War on Poverty. Naishtat's background and career have definitely shaped his interests on the war on poverty, to better understand his position on the CHIP bill look here.
Analysis of the CHIP Bill:
General CHIP provisions: HB 2962 would increase family allowable asset limit from $10,000 to $20,000. Under the currnet plan, a family's vehicle is considered as an asset and caps that value at $18,000. Under the proposed bill that cap will be eliminated from the calculation of such allowable assets. Child support payments will also be excluded from assets when determining eligibility. Review of CHIP enrollees at the six month mark in order to determine ongoing eligibility will also be eliminated.
Increased CHIP eligibility: Enrollees whose net family incomes were greater than 200 percent but less than 300 percent of the federal poverty level are required to pay a share of the CHIP plan costs, not to exceed 5% of the enrollees net family income. Payment for the plan will be obtained through co-payments, fees and assessing a plan premium. The House bill proposes that plan coverage will be terminated for non-payment of premiums and that if a family's net income increases, that family's share costs will also increase.
CHIP buy-in program: This is a program that would be adopted by the executive of the Health and Human Services Commission (HHSC) that would allow certain children whose net family incomes that were greater than 300% of the federal poverty level but not exceeding 400% to buy CHIP coverage at the same cost that HHSC would pay for coverage. Children would only be eligible for thihs program if they had previously been enrolled in CHIP or Medicaid but were no longer eligible for the plans based on an increase in family income. This is a full cost buy-in option, that would be at no cost to the state.
Community Outreach: Under HB 2962, the HHSC would be required to improve existing public education regarding CHIP, assist with applications, and issue resolutions in eligibility determination processes.
Exclusion of college savings plans: Under HB 2962, the HHSC could no longer consider assets for college savings plans for the purpose of establishing income and resource eligibility.
The Timeline for HB 2962:
First Stage: Bill filed by Coleman on 3/10/2009.
Second Stage: Bill reported out of House committee on Human Services on 04/28/2009 with vote of 8 Ayes, 0 Nays, 0 Present Not Voting, 1 Absent.
Third Stage: Bill passed the House on 5/17/2009
The current status of the Bill as of June 1st, 2009: The Bill dies on the floor of the Senate
LInk to the statesman.com: What passed and what didn't in the 81st Legislative Session here
Arguments For and Against the CHIP Bill:
In a Texas House of Representatives News Release on May 18, 2009, Rep. Ellen Cohen stated that,"Children living in middle-income families are increasingly joining the ranks of the uninsured because employer-based health insurance premiums have more than doubled since 2000. Reducing the number of uninsured children, now one in five, would benefit not only the children's physical health but the fiscal strength of Texas taxpayers."
In a quote in the Texas Insider, Rep. Roberto Alonzo D-Dallas, a co-author of HB-2962 says,"I am proud indeed to go bat for the innocent, voiceless children of Texas because they deserve our love and support. There is no doubt in my mind that any investment we make in our children today-- including adequate health care coverage--will translate into savings in the future many times over. And unless we take care of them now, we may be faced with much more serious problems and costly expenses later if we fail to act as policymakers."
Rep. Veronica Gonzales, D-McAllen, a supporter and co-author of the CHIP bill stated in the Rio Grande Guardian,"This is not an entitlement program. The average cost in Texas for private family health care coverage is $900 a month. Many families are now earning a few dollars more than the current eligibility level. The extended CHIP coverage will not only improve the health care of Texas children, it will also save the state money due to less costly emergency room visits and bring our state $3 federal match for each dollar we spend on CHIP."
Rep. Garnet Coleman, D-Houston offers his opinion on the bill," CHIP is not an entitlement program. These families pay to participate. The way Texas has laid it out, the families who partiucipate understand its not a free ride. We are ensuring that private health insurance is not substituted by CHIP coverage by including new, strict anti-crowd out provisions in this bill. Parents of children covered under the new provisions will contribute more to the cost of their children's health care than the state."
The Texas Chip Coalition is a public education and advocacy group that formed in 1988 and whose sole purpose is to support adequate state funding and program improvements for CHIP. The Texas Chip Coalition Principles designed for the 81st Legislative Session is included here.
Talmadge Heflin, the director of the Texas Public Policy Foundationfor Fiscal Policy shares his views regarding the passage of the CHIP House Bill,"Today's House vote is a harmful step toward a big government healthcare system. If Texas extends CHIP to families making more than $66,000 per year, what was originally a health insurance program for the working poor will morph into an expensive entitlement for the middle class.The buy-in option for families making more than $66,000 will crowd out the private insurance market, making health insurance less accesible and more expensive for families that do not qualify for CHIP. "
Governor Rick Perry expresses his opinion regarding the CHIP bill and its inclusion of the broader income eligibility criteria,"I would probably not be in favor of that expansion, even if it came to my desk. The members know that.That’s not what I consider to be a piece of legislation that has the vast support of the people of Texas.” In the 81st Legislative Session Governor Rick Perry has threatened to veto anybill related to expanded CHIP coverage.
Rep. Jodie Laubenberg, R-Parker, is also opposed the CHIP expansion and has assured her district that her opposition to the CHIP plan has, “nothing to do with children. It’s just more expansion of government health care. CHIP is the door to universal health care."
In response to Laubenberg's statement, Anne Dunkelberg, associate director of the Center for Public Policy Priorities, which advocates for low- and middle income Texans,“Today, the House ignored the will of the majority of Texans who wanted their state officials to do something about the growing number of uninsured children.”
This final statement by Dunkleberg really punctuates the knowledge that we gained in class about the power of government and whether or not government serves to reflect and represent its people.